Darcy A. always knew he wanted to have a child. Biologically born female, Darcy came out as a lesbian at the age of 12 and then as a transgender male at 18.
"I always knew that I would have a partner who did not have sperm and figured we would both carry children," he told CBS News.
In November 2014, after being inseminated with sperm from a donor, Darcy, who asked that his last name not be used, gave birth to baby Hayden.
The pregnancy was hard, rattled with seemingly never-ending morning sickness and lots of pain.
Adding to the difficulties, Darcy's health care providers weren't always equipped to handle the unique needs of a pregnant transgender man.
"They didn't use the right pronouns when addressing me," he said. "They didn't know how to do pelvic exams on someone who had never had sex vaginally with a man -- meaning nothing fits in there."
Darcy's experience is all too common for transgender men who choose to have children -- and it reflects widespread gaps in medical care for the transgender community as a whole.
Research shows transgender people often postpone medical care due to discrimination or concern about how they'll be treated, and many say they've needed to teach their health care providers about transgender care. Some have even been refused treatment because of their transgender or gender non-conforming status.
A 2015 report from the New York Academy of Medicine on transgender access to quality health care describes how harrowing the experience can be. "We've gotten calls from people who have gotten thrown out of gynecologists' offices because they'll say we don't see men... then they have to explain that they have female anatomy and the doctors are so uninformed," a trans woman and LGBT care provider said.
Although not well tracked -- and barely discussed in the media -- researchers say the experience of transgender men having babies is more common than most people may think. As such, experts say health care providers need to be better prepared to offer medical care to this population.
"Transgender individuals are really one of the most under-served, under-studied groups that are vulnerable to poor health and really need focused attention to meet their needs in evidence-based and culturally sensitive ways," Dr. Juno Obedin-Maliver, a fellow in obstetrics and gynecology at the University of California San Francisco and San Francisco Veterans Affairs and founder of the Lesbian, Gay, Bisexual, and Transgender Medical Education Research Group Stanford University School of Medicine, told CBS News.
Obedin-Maliver couldn't say exactly how common transgender pregnancies are, as they are not included in major obstetrical studies and most OB/GYN's don't ask about gender identity. But she said she sees these patients in her own practice and gets many consult requests from doctors and providers around the country asking questions about how to provide proper care for this population.
Training for health care providers
In response to the lack of information and increasing interest among providers, Obedin-Maliver, along with Dr. Harvey Makadon, director of the National LGBT Health Education Center at the Fenway Institute, in Boston, wrote an editorial published in the journal Obstetric Medicine last October calling attention to the need for greater support for pregnant transgender men.
In it, they argue that health care systems need to have training programs implemented to instruct everyone from receptionists to physicians on gender affirming policies and behaviors.
An important aspect of this training is assuring that everyone uses the correct pronouns when addressing patients.
"It boils down to respect," Morgan Weinert, who identifies as gender queer (someone who does not subscribe to conventional gender distinctions) and uses the pronouns "he" or "they," explained. "Using someone's correct pronoun shows them that you respect them as a person and honor their identity. Pronouns are personal, like names. By ignoring a trans person's preferred pronouns, you're ignoring their core identity. You're telling them you don't 'see' them in their preferred identity, and that you don't respect the choice they've made." Weinert, who was biologically born female, became pregnant through a sperm donor and gave birth last year to a baby named Early with his partner Aaron, who identifies as a trans man.